The influence of authentic leadership on nurses' turnover intentions and satisfaction with quality of care in Saudi Arabia: A structural equation modelling study.

AIM(S): The study aimed to test a model that examined the relationships between authentic leadership, psychological safety, work engagement and team effectiveness and subsequent effects of team effectiveness on job turnover intentions and nurse satisfaction with quality of care. BACKGROUND: Nurse leaders who exhibit authentic leadership have been shown to contribute to the development of healthy work environments. In workplaces with demonstrated authentic leadership, nurses are more engaged and have lower job turnover intentions. METHOD(S): A non-experimental, cross-sectional design was used to test the hypothesized model via structural equation modelling. A total of 456 nurses were included. RESULTS: Structural equation modelling analysis indicated a good fit for the hypothesized model. Authentic leadership had a positive, significant and direct relationship with team effectiveness, nurses' work engagement and psychological safety. Team effectiveness was found to be negatively related to job turnover intentions but positively related to nurse satisfaction with quality of care. CONCLUSION(S): Results of this study may help nursing leaders have a better understanding of the essential role of leadership style in increasing healthy work environments. IMPLICATIONS FOR NURSING MANAGEMENT: Applying authentic leadership style in nursing practice could help to reduce the shortage of nurses stemming from the high turnover intentions of nurses.

Assessing the association between periodontitis and premature birth: a case-control study.

BACKGROUND: Premature delivery is among the leading causes of perinatal mortality and morbidity in developed societies, which is an important obstetrics problem. Maternal periodontitis is a prevalent condition that has been suspected to be associated with adverse pregnancy outcomes such as premature birth. However, there are still conflicting results about this possible relationship, therefore this study was designed to test the association between maternal periodontitis and premature birth. This study also provides information about a new screening tool recommended for use by nurses and midwives to screen for periodontal diseases during antenatal consultations in order to improve the health of mothers and children. METHODS: A retrospective case-control study was conducted at 12 health facilities in the Southern Province of Rwanda from February to August, 2018. A total of 555 women in the postpartum period were enrolled in the study. Cases and controls were enrolled in a ratio of 1:2; each enrolled case of preterm birth was followed by 2 unmatched control subjects that were next on the register and who delivered at term gestation. A total of 185 cases of preterm deliveries and 370 controls of term delivery were enrolled in the study. Multivariate regression analysis was used and the independent variables were hierarchically entered in three groups: The first group involved demographic variables that were put in the regression model as Step 1. The second group was made up of other potential risk factors that were placed in the regression model as the second step. Periodontitis was entered in the final regression step, as it was hypothesized as the main predictor variable. RESULTS: A statistically significant association was found between periodontitis and premature birth. Women who had periodontitis had 6 times the odds of giving birth to premature birth infants compared to women who had no periodontitis (OR: 6.360, 95% CI 3.9, 10.4). CONCLUSION: The study results indicate that periodontitis is strongly associated with premature birth. Preventive solutions including the use of a periodontitis screening tool for nurses and midwives during antenatal care consultations, are highly recommended.

Factors affecting job satisfaction among acute care nurses working in rural and urban settings.

AIMS: To: (a) identify the differences and similarities in the extrinsic and intrinsic factors that influence job satisfaction among nurses in urban and rural Ontario; and (b) determine the impact of job satisfaction on nurses' turnover intention among nurses working in rural and urban settings in Ontario. DESIGN: Cross-sectional correlational design was used for this study. METHODS: Data were collected between May 2019-July 2019 in southern Ontario. Participants (N=349) completed the Acute Care Nurses' Job Satisfaction Scale and The Anticipated Turnover Scale. A stratified sampling technique was used for recruiting the sample population and participants were given the option to respond either online or by mailed survey. RESULTS: There was no significant difference between rural and urban nurses in either overall job satisfaction level or turnover intention. Peer support/work conditions, quality of supervision, and achievement/job interest/responsibility were significant predictors of job satisfaction. There was a significant difference between rural and urban nurses in terms of satisfaction from benefits and job security and the nurses' job satisfaction levels correlated negatively with their turnover intention. CONCLUSION: Several extrinsic and intrinsic factors are associated with nurses' job satisfaction in rural and urban settings. Developing strategies that improve satisfaction by modulating these specific factors may improve nurses' job satisfaction and reduce turnover. IMPACT: This study discussed how working in a rural or urban hospital may affect nurses' job satisfaction and turnover intention. The findings can help in improving nurses' job satisfaction and inform workforce planning to increase nurses' retention.

Factors affecting nurses' job satisfaction in rural and urban acute care settings: A PRISMA systematic review.

AIMS: This review aimed to systematically assess the findings of primary studies to identify the factors associated with nurse job satisfaction in rural and urban contexts while analysing the findings according to Herzberg's theory. BACKGROUND: While there is evidence linking several factors to nurses' job satisfaction, gaps still exist in understanding the differences between factors affecting job satisfaction for nurses working in rural and urban settings. DESIGN: Systematic review with narrative summary. DATA SOURCES: Six databases were used to identify original studies that discuss the factors associated with the nurse's job satisfaction between 1998-2018. REVIEW METHODS: Two authors independently reviewed each study using the Joanna Briggs Institute's critical appraisal checklists. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to report and examine the study biases systematically. RESULTS: A total of 38 studies were selected for this review. Physical working environment and authority and freedom were the most frequently reported factors associated with nurses' job satisfaction. Several extrinsic, intrinsic, personal, and community factors were also found to be associated with nurses' job satisfaction. Urban studies tended to focus on extrinsic factors, whereas there was more balance between the two sets of factors in rural studies. CONCLUSION: Both intrinsic and extrinsic factors play an essential role in nurses' job satisfaction. Future research should use more robust research methods and pay more attention to contrasting rural and urban contexts. Herzberg's theory can provide conceptual clarity when investigating the factors associated with nurses' job satisfaction. IMPACT: This review discussed the factors associated with nurses' job satisfaction in rural and urban settings. The findings linked several extrinsic and intrinsic factors to nurses' job satisfaction. Nursing management should search for the perfect blend of intrinsic and extrinsic factors based on nurses' needs and organizational commitment to improve nurses' job satisfaction.

Professional practice leadership roles: the role of organizational power and personal influence in creating a professional practice environment for nurses.

Professional practice leadership (PPL) roles are those roles responsible for expert practice, providing professional leadership, facilitating ongoing professional development, and research. Despite the extensive implementation of this role, most of the available literature focuses on the implementation of the role, with few empirical studies examining the factors that contribute to PPL role effectiveness. This article will share the results of a research study regarding the role of organizational power and personal influence in creating a high-quality professional practice environment for nurses. Survey results from nurses and PPLs from 45 hospitals will be presented. Path analysis was used to test the hypothesized model and relationships between the key variables of interest. Results indicate that there is a direct and positive relationship between PPL organizational power and achievement of PPL role functions, as well as an indirect, partially mediated effect of PPL influence tactics on PPL role function. There is also a direct and positive relationship between PPL role functions and nurses' perceptions of their practice environment. The evidence generated from this study highlights the importance of organizational power and personal influence as significantly contributing to the ability of those in PPL roles to achieve desired outcomes. This information can be used by administrators, researchers, and clinicians regarding the factors that can optimize the organizational and systematic strategies for enhancing the practice environment for nursing and other health care professionals.

Assessing the Impact of Community Factors on Acute Care Nurses' Job Satisfaction and Turnover Intention.

BACKGROUND: Community factors may affect nurses' job behavior and decision making. There is a gap in the literature regarding the impact of community satisfaction, family ties, and community preferences on acute care nurses' turnover intention and job satisfaction. Furthermore, no studies have examined the differences in community satisfaction, community preferences, and family ties among nurses working in rural and urban settings. PURPOSE: To identify the impact of family ties, community satisfaction, and community preferences on turnover intention and job satisfaction among acute care nurses working in Ontario's urban and rural areas. METHODS: Descriptive correlational survey design was used in this study. A targeted stratified sampling technique was used to recruit acute care nurses working in Ontario's urban and rural areas (N = 349) between May 2019 and July 2019. Dillman's approach was used to guide data collection. Parametric and non-parametric tests were used for data analysis. RESULTS: A significant association was found between working settings and community preferences. A statistically significant positive relationship between community satisfaction and nurses' job satisfaction was identified. Furthermore, community satisfaction had a negative impact on turnover intention. Neither community preference nor family ties were significantly associated with turnover intention or job satisfaction. CONCLUSION: The study suggests that community satisfaction can influence important nurse work-related outcomes. Future studies should replicate and validate these results in different contexts and cultures. Retaining nurses may be difficult if they are not satisfied with their communities.

An integrative review of nursing leadership in Saudi Arabia.

AIMS: The aims of this integrative review were to describe leadership styles from the nursing literature in Saudi Arabia and to identify the current state of evidence about relationships between leadership styles and nurse, patient and organization outcomes in Saudi Arabia. DESIGN: Integrative review was used as a design for this study. METHODS: The following search terms were used with databases: 'Saudi Arabia', 'leadership theory*', 'leadership style*', 'leadership model*', 'management style' and 'nurse*'. Methodological quality was assessed using two different quality rating tools for quantitative and qualitative studies. Databases used for this review included Nursing & Allied Health Database, Cochrane Database of Systematic Reviews, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science and ProQuest Dissertations & Theses. RESULTS: Nine manuscripts representing eight studies were included in this review. The papers reviewed included quantitative (n = 6), qualitative (n = 2) and mixed methods studies (n = 1). Results were grouped into different themes, identified as nursing leadership styles in Saudi Arabia, leadership styles and nurses' outcomes, and demographics and leadership styles.

Development and Testing of an Acute Care Nurses' Job Satisfaction Scale.

BACKGROUND AND PURPOSE: Factors affecting nurses' job satisfaction in the acute care setting may differ from nurses working in other settings. The aim of this study was to develop a new tool that measure the job satisfaction of acute care nurses who provide direct patient care. METHODS: Content validity then exploratory factor analysis (EFA) were used for validation of the new tool using a random sample of 349 acute care nurses. RESULTS: The EFA resulted in 31 items suggesting 6 factors were present in the instrument. The identified factors were: achievement/job interest/responsibility, hospital policy, quality of supervision, peer support/work condition, growth/advancement, and benefits/job security. CONCLUSION: A new tool for measuring acute care nurses' job satisfaction was developed based on a robust theoretical foundation and demonstrated sound psychometric properties.

Depression in nurses.

Patient outcomes are reliant on nursing calibre, which in turn is dependent on the health of work environments and practice settings. The National Survey of the Work and Health of Nurses (NSWHN) examined a broad spectrum of nurses' work and health, with one finding of particular concern: Nurses have a higher rate of depression (1 in 10) than their counterparts (as found in other national surveys). This secondary analysis of the data focused on the outcome of depression in a subsample of the nurses surveyed by the NSWHN and examined associations between depression and work-related variables such as job strain, role overload, respect, social and employer supports, and nurses' perception of the quality of the care they provided. A multivariate logistic regression found an increased risk of depression in nurses experiencing job strain, role overload, and a lack of respect.

Can an expanded and integrated occupational health service help buffer the impact of a global influenza outbreak in healthcare organizations?

At first glance, the accompanying article by Silas et al. makes for a somewhat-curious read. The picture they paint of the possible risk of a global pandemic posed by the avian influenza virus H5N1 is indeed a chilling one, not only for the possible extent of the epidemic itself but also because of the likely burden it could place on an already thinly stretched healthcare workforce. It therefore raises a rather alarming contradiction. Given our recent experience of living through the consequences of the outbreak of severe acute respiratory syndrome in Ontario and BC, one would think that we would be more than willing this time around to err on the side of caution and be as prepared as possible to deal with the next emerging infectious agent that comes our way. But, surprisingly, as is carefully outlined in Silas et al.'s paper, this does not seem to be the case. In a healthcare environment that is increasingly focused on the need for evidence upon which to base change in practice, are we possibly dragging our heels in raising our preparedness for a future pandemic? It is an interesting debate, and one that certainly merits further examination.

The challenge of effective workplace change in the health sector.

There is significant personal injury risk associated with the provision of high-quality healthcare. The magnitude of this risk, combined with the possibility that it can often go underappreciated by caregivers and the organizations they work for, might help explain why the health sector has largely missed out on the benefits of an overall declining trend in injury rates. Despite covering two very different topics in their lead papers, Shamian and El-Jardali and Clements, Dault and Priest present a surprising degree of overlap in relation to what might help enable effective workplace change. Leadership, role clarity, trust, respect, values and workplace culture are all viewed as key enablers of effective teamwork by Clements, Dault and Priest. They could also be considered required ingredients of successful workplace health initiatives, as discussed by Shamian and El-Jardali. A lot of background and positional work regarding teamwork and healthy workplaces exists, but this has not necessarily translated into front-line change. These authors have done an excellent job of pointing out the potential benefits of workplace changes. What is needed now is for someone to take the lead in developing, implementing and evaluating these changes. The adult human form is an awkward burden to lift or carry. Weighing up to 200 pounds or more, it has no handles, it is not rigid, and it is susceptible to severe damage if mishandled or dropped. When lying in bed, a patient is placed inconveniently for lifting and the weight and placement of such a load would be tolerated by few industrial workers.

Back belt use for prevention of occupational low back pain: a systematic review.

BACKGROUND: Back pain continues to be the leading overall cause of morbidity and lost productivity in the workplace. Recently, there has been a renewed interest in the use of back belts by industry to reduce occupational low back pain (LBP). OBJECTIVES: To examine the literature and evaluate the effectiveness of back belt use for the primary prevention of occupational LBP. METHODS: MEDLINE, CINAHL, EMBASE, and HEALTHSTAR were searched for relevant articles published up to July 2003. Studies were included if participants were material handlers, and outcomes included the incidence and/or duration of lost time of reported LBP among workers who wore back belts compared with those who did not. The quality of the evidence was scored independently by 2 reviewers using a double rating method, first according to research design followed by an internal validity rating. Final synthesis of the evidence was performed in which the evidence was classified as good, fair, conflicting, or insufficient. RESULTS: Ten epidemiologic studies meeting inclusion criteria were identified. Of 5 randomized controlled trials, 3 showed no positive results with back belt use; 2 cohort studies had conflicting results; and 2 nonrandomized controlled studies and 1 survey showed positive results. CONCLUSIONS: Currently, because of conflicting evidence and the absence of high-quality trials, there is no conclusive evidence to support back belt use to prevent or reduce lost time from occupational LBP.

Professionalizing familial care: examining nurses' unpaid family care work.

An emergent grounded theory was used to examine Professionalizing Familial Care, the processes by which registered nurses enact professional care work within the familial care domain. A sample of registered nurses (n = 32) were interviewed by telephone at multiple time points over a 6- to 12-month period. The findings revealed that the professionalization of care work was often reinforced by societal, familial, and self-expectations. Setting Limits and Making Connections were the dialectical overarching processes shaping the professionalizing of care while 6 interdependent substrategies emerged: assessing, advising, advocating, collaborating, coordinating, and consulting. These findings will help inform refinement of policies and practices for nurses who provide care for an older relative.

Evaluation of a participatory ergonomic intervention aimed at improving musculoskeletal health.

BACKGROUND: Participatory ergonomic (PE) interventions have been increasingly utilized to deal with work-related musculoskeletal disorders (WMSD). METHODS: Using a longitudinal quasi-experimental design, a PE process was launched at one depot of a large courier company, with a nearby depot serving as a control. Evaluations focused on 122 employees across the two depots who participated in both pre- and post-questionnaires. An evaluation framework assessed the process of implementation, changes in risk factors, and changes in musculoskeletal health outcomes. Partial and multiple regressions explored the relationships in the evaluation framework. RESULTS: Changes in work organizational factors had a consistent impact upon changes in health outcomes. Greater participation in the process was associated with increased levels of job influence and communication (P = 0.0059 and P = 0.0940 respectively). Improvements in communication levels were associated with reduced pain intensity and improved work role function (WRF) (P = 0.0077 and P = 0.0248 respectively). Lower levels of pain post-intervention were related to greater WRF (P = 0.0493). CONCLUSIONS: A PE approach can improve risk factors related to WMSD, and meaningful worker participation in the process is an important aspect for the success of such interventions.

New strategies for monitoring the health of Canadian nurses: results of collaborations with key stakeholders.

The aim of this descriptive study was to help policy- and decision-makers enhance the health of the Canadian nursing workforce by highlighting key factors of concern and exploring options for collecting and utilizing nurses' health data. This paper describes the views of 62 nursing stakeholders from a diverse spectrum of professional, labour, management and government perspectives from across Canada, regarding key factors contributing to work-related health problems in the nursing profession, particularly those relating to the work environment and hospital restructuring. The results were combined with a synthesis of existing information sources about the health of nurses in Canada. With respect to the key concerns, musculoskeletal conditions/injuries and stress and burnout were identified as nurses' major work-related health problems. An examination of the data synthesis inventory revealed that no existing data sources can adequately profile nurses' health, especially in relation to the components of the Conceptual Model of Nurses' Health developed in the study. Three strategies for monitoring nurses' health are proposed.

The psychometric properties of Karasek's demand and control scales within a single sector: data from a large teaching hospital.

OBJECTIVE: This paper reviews the psychometric properties of the core components from Karasek's job content questionnaire, the decision latitude and psychological job demands scales. METHODS: A self-reported survey was administered in 1995 (time 1), 1996 (time 2), and 1997 (time 3) to employees of a large teaching hospital. Analyses for this paper are based on data from the 484 employees who responded at times 1 and 2. RESULTS: Both scales demonstrated acceptable internal consistency as assessed by item-total correlations and Cronbach's alpha. In confirmatory factor analysis, the two-factor decision latitude model adequately fit the data. However, our findings suggest that a two-factor model may provide an improved fit over the original one-factor demands model, suggesting that this scale may be two distinct subscales. Lastly, the scales demonstrated acceptable discriminant validity. CONCLUSION: Apart from some guarded uncertainty over what the demands scale may be measuring, overall, the two scales appeared to perform reasonably well in this sample of health care workers.

Staff nurse empowerment and effort-reward imbalance.

The purpose of this study was to test an expanded model of Rosabeth Moss Kanter's Structural Theory of Organizational Behaviour (Kanter 1977; Laschinger, Finegan, Shamian and Wilk 2001) by examining the relationship between nurses' empowerment and their perceptions of effort-reward imbalance (Siegrist 1996). A sample of 112 staff nurses employed in teaching hospitals in Ontario participated in this study (58% return rate). A descriptive correlational survey design was used to collect data by eLiciting responses to five self-report instruments: the Conditions of Work Effectiveness II, the Job Activities Scale II, and the Organizational Relationships Scale II (Laschinger, Finegan, Shamian and Wilk 2001), the Effort-Reward Imbalance (ERI) scale (Siegrist and Peter 1999a) and a demographic questionnaire. Staff nurses were only moderately empowered, and 24.1% perceived their work to have more efforts than rewards, according to Siegrist's guidelines.